Alopecia areata (AA) is a common disease of the hair follicle characterized by the appearance of patchy areas of hair loss leaving a smooth and nonscarred scalp. AA is a T-cell-mediated autoimmune disease with cytokines playing an important role. Follicular melanocytes is an important target in the autoimmune process of AA, and AA may have an effect on hearing function by affecting the melanocytes in the inner ear. Our study aimed at investigating autoimmune hearing loss in Egyptian patients with AA in comparison with controls. The study included 40 participants - 20 AA patients and 20 controls. All patients were subjected to a detailed history taking and examination to detect type, extent of AA in addition to complete clinical, otoscopic and audiological examination, including high frequencies for both ears of patients and age-matched controls. The study revealed a significant presence of sensorineural hearing loss in AA patients in comparison with controls. This hearing loss had a direct correlation with the disease severity, duration and the recurrence of attacks.

Objectives
This study aimed to study the effect of combined pegylated interferon and ribavirin (Peg-IFN/RBV) therapy on the hearing profile of patients with hepatitis C virus (HCV).
Materials and methods
The auditory system of a total of 74 chronic HCV patients was assessed using pure tone audiometry (conventional and high frequency) and distortion product otoacoustic emissions (DPOAEs in the form of a DP-gram) immediately before therapy and at the end of the 12th and 24th weeks. Vestibulocochlear adverse effects including hearing loss, tinnitus, vertigo, and otalgia were also considered.
Results
Significant elevations in hearing thresholds were found on comparing thresholds at the 12th and 24th weeks with those at the onset of the study. The elevations were mostly at higher frequencies (3000, 4000, 6000, 8000, 9000, 10 000, 11 200, and 12 500 Hz), and did not affect speech perception. For DPOAE, significant differences were observed at all F2 frequencies on comparing both amplitudes and signal to noise ratios at the 12th and 24th weeks with those before therapy, with significance appearing earlier for higher F2 frequencies. Otologic complaints were insignificant, except for tinnitus; a significant increase in tinnitus was observed from 0 to 31.1% by the end of the study.
Conclusion
Significant auditory adverse effects may result from combined Peg-IFN/RBV therapy in HCV patients, highlighting the importance of prompt monitoring of auditory functions in these patients.

Eagle syndrome is a symptom complex of recurrent throat pain, dysphagia, foreign body sensation, otalgia or orofacial pain resulting from elongated styloid process or mineralization of stylohyoid ligament. Elongated styloid process may stretch the cranial nerves in its vicinity, or compress the perivascular sympathetic fibers around the carotid arteries. Multidetector-row computed tomography helps in the easy and accurate diagnosis of Eagle syndrome by means of enhanced demonstration of the elongated styloid processes. We present the case of Eagle syndrome in a 35-year-old woman with a long history of facial pain. Multidetector-row computed tomography with three-dimensional reconstruction was performed, which demonstrated bilateral elongated styloid processes.

The study of convergence insufficiency in children with attention deficit hyperactivity disorderDina A Elsayed, Rania M AbdouOctober-December 2015, 31(4):250-253DOI:10.4103/1012-5574.168361

Introduction
Attention deficit-hyperactivity disorder (ADHD) is characterized by low levels of attention and concentration and high levels of activity, distractibility, and impulsivity. Convergence insufficiency (CI) is a common condition that is characterized by a patient's inability to maintain proper binocular eye alignment on objects as they approach from distance to near. Several studies have been conducted to discover the relationship between ADHD and CI. Researchers reported that children with CI had a higher frequency of parent-reported ADHD and/or learning problems, but their studies were limited to patients with CI.
Aim of the work
The purpose of this study was to identify patients with CI in a cohort of patients diagnosed with ADHD.
Materials and methods
The study included 20 children diagnosed with ADHD. They were diagnosed on the basis of the clinical assessment and fulfilling the diagnostic criteria of the DSM-IV. Other assessments included mental age assessment using the Stanford-Binet scale and ADHD assessment using Conners' parents rating scale. Participants underwent complete ophthalmologic examination: visual acuity test using an illiterate E chart; stereopsis using Lang card; cover tests; convergence amplitude; near point of convergence; slit-lamp examination for the anterior segment; cycloplegic refraction; and fundus examination. Written informed consent was taken from the parents of all children included in the study.
Results
CI was present in 35% of cases, with a near point of convergence more than 6.
Conclusion
CI appeared to be a comorbid disorder in patients with ADHD, and may cause misdiagnosis, or exacerbation of the symptoms of ADHD. Patients diagnosed with ADHD should be evaluated for CI. It is worthy of mention that CI is a disease that can be effectively managed with orthoptic exercises, or surgically.

Purpose
The aim of the study was to determine the size and distribution of language disorders among low birth weight (LBW) children to devise a plan for early detection, proper assessment, intervention, and prevention of these problems if possible.
Patients and methods
Eighty children were included in this study. The study group consisted of 50 children with a history of LBW, 31 boys and 19 girls, with a mean age of 4.3 ± 1.6 years. The control group consisted of 30 children with a history of normal birth weight, 13 boys and 17 girls, with a mean age of 5.1 ± 1.3 years. Children in the two groups were statistically matched in their age and sex distribution. All participant children were subjected to an interview, general examination, vocal tract examination, neurological examination, ENT examination, evaluation of various aptitudes by formal testing, psychiatric evaluation, audiological examination, and language evaluation using the Arabic Preschool Language Scale-4.
Results
The results from this study revealed that LBW in addition to poor neonatal outcome and prematurity was an important risk factor for poor language abilities in children.
Conclusion
Early consultation is recommended for LBW children with high risk factors in order to facilitate early detection and proper management of language disorders.

Objective
To evaluate the effectiveness of using topical nasal steroids versus oral steroids in the treatment of otitis media with effusion (OME) in children.
Methods
One hundred (100) patients were included in the study, they were divided into two equal groups, group A received intranasal mometasone furoate spray once daily for 6 weeks, and group B received oral steroids in tapering doses for 6 weeks, plus systemic antibiotics, and nasal decongestants for both groups, tympanogram was done every 2 weeks for all patients.
Results
Highly significant improvement (P < 0.01) of OME regarding symtoms, signs, and tympanometric results, occurred in each group separately at the end of the study, with no significant difference (P > 0.05) in improvement between the two groups.
Conclusion
Both topical intranasal and oral steroids are effective medical therapy in the treatment of OME in children with no significant difference between the two methods.

Objective
The aim of the study was to assess the role of the intranasal prelacrimal recess approach (PLRA) in complete removal of anterior maxillary lesions.
Study design
This was a prospective study in which 20 patients were recruited between July 2013 and September 2014 from the Otorhinolaryngology outpatient clinic, Cairo University.
Patients and methods
Patients with anterior maxillary sinus (MS) lesions underwent endoscopic sinus surgery and had their lesions removed through the maxillary ostium. The PLRA was then performed to assess the presence of any anterior maxillary remnants, which were then removed.
Results
The intranasal pathologies included sinonasal polyposis (four patients), recurrent sinonasal polyposis (four patients), antrochoanal polyps (four patients), allergic fungal sinusitis (five patients), inverted papilloma (one patient), lymphoma (one patient), and cancer maxilla (one patient). After the PLRA 45% of the patients showed remnants. These included antrochoanal polyp (two patients), recurrent sinonasal polyposis (one patient), allergic fungal sinusitis (three patients), inverted papilloma (one patient), lymphoma (one patient), and cancer maxilla (one patient).
Conclusion
Our preliminary study demonstrated that without the PLRA 45% of the cases will have remnants missed in hidden areas of the MS. The PLRA is a minimally invasive technique to deal with anterior MS lesions.

Objectives
The aim of this study is to assess the role of simple conchopexy suture in maintaining a widely patent middle meatus during the phase of postoperative healing (and its effect on olfaction); this enables delivery of topical medication and sinus aeration compared with functional endoscopic sinus surgery (ESS) with and without bolgarization of the middle turbinate (MT).
Patients and methods
This study included 39 patients. Patients were divided into three equal groups randomly; each group included 13 patients. Group A underwent ESS with suture medialization of the MT (method), group B underwent ESS with bolgarization of the MT, and group C underwent normal ESS. Items of comparison between the three groups included both subjective and objective parameters such as symptoms (nasal obstruction, facial pain, and smell) and endoscopy findings. All the patients underwent preoperative and 2-month postoperative assessment with a questionnaire, smell test, and endoscopic examination.
Results
In terms of nasal obstruction in all three groups, there was a statistically significant improvement (P = 0.001, 0.001, and 0.002, respectively). Improvement in facial pain was statistically highly significant in group A (P = 0.0007), whereas it improved significantly in groups B and C (P = 0.001 and 0.002, respectively). Improvement in smell was statistically insignificant in all three groups (P = 0.4). The postoperative endoscopy findings improved compared with the preoperative findings in all three groups.
Conclusion
MT conchopexy and bolgarization of the MT have no detectable adverse effects on olfaction. No lateral synechia was detected, and there was a highly significant improvement in facial pain scores were observed in patients who underwent concopexy; patients who underwent middle turbinate bolgarization also showed improvement in both aspects, but in a lower percent. Both conchopexy and bolgarization of the MT after conventional ESS may help improve postoperative ostiomeatal complex patency, mucosal healing, and minimize adhesions, with no adverse effect on olfaction.

Background
Tinnitus is a common and distressing symptom that is characterized by the perceived sensation of sound without a corresponding external stimulus. Intratympanic (IT) dexamethasone injection is used for the treatment of tinnitus by introducing the substance through the tympanic membrane, resulting in reduced systemic toxicity and a higher perilymph steroid level.
Aim of the study
The aim of this study was to evaluate the effect of IT dexamethasone injection for controlling idiopathic tinnitus of cochlear origin.
Materials and methods
A total of 30 patients with subjective idiopathic tinnitus for at least 6 months were subjected to IT injection of dexamethasone, once per week for 4 weeks. Improvement in tinnitus was assessed using pure-tone audiometry, speech audiometry, tinnitus matching test, and Tinnitus Handicap Inventory by comparing the results before and after therapy.
Results
Pure-tone audiometry did not show significant improvement. However, there was a significant improvement in speech audiometry, tinnitus loudness, and Tinnitus Handicap Inventory after the end of the four injections and in the subsequent evaluations 1 and 3 months later.
Conclusion
IT dexamethasone injection could be a simple and effective method for controlling subjective idiopathic tinnitus. The tinnitus may not disappear, but will be alleviated, enabling the patient to cope more easily with the disease, and thus reducing their handicap.

Objective
Management of a severely compromised airway because of bilateral paralysis of the vocal cords represents a significant challenge. The aim of this study is to establish the validity and accuracy of ultrasonography in the evaluation of CO 2 laser surgery using optical endoscopy as the gold-standard technique.
Participants and methods
A thorough ultrasonographic examination of the vocal cords during different phases of respiration and phonation, both pre-CO 2 and post-CO 2 laser surgery, was performed. Endoscopic partial transverse cordectomy, using a CO 2 laser, was the operation of choice in the management of bilateral vocal cord paralysis. Thirty-six patients were included in this study; a control group of 125 normal volunteers was also included for standardization of the ultrasonographic technique.
Results
Patients with bilateral immobility of the vocal cords (36) in the adduction position were subjected to a CO 2 laser. Endoscopic partial transverse cordectomy was performed. Twenty patients required unilateral laser surgery because the anterior angle was 12° or greater by ultrasound measurement. Postoperative follow-up of the anterior angle increased from 14° to 26°, whereas 16 patients (45%) required bilateral laser surgery as the anterior angle was less than 12° on ultrasound. Postoperatively, the anterior angle increased from 16° to 26°.
Conclusion
Ultrasonography is the modality of choice in the evaluation of patients with bilateral vocal cord paralysis quantitatively and dynamically. These might improve the functional results of one-step CO 2 laser surgery.
Level of evidence:
4.